Determinants of bone density in normal women: risk factors for future osteoporosis?

Association between alcohol intake and bone mineral density: results from the NHANES 2005-2020 and two-sample Mendelian randomization

We used the data from the NHANES cross-sectional study among 14,113 participants and indicated a positive correlation between alcohol intake frequency and bone mineral density in different body sites. Mendelian randomization was conducted, and no causal relationship is significant between these two variables. The study can provide some suggestions on the daily consumption of alcohol for osteoporosis patients.

PURPOSE

The effect of alcohol intake on bone mineral density (BMD) remains unclear. This study explored the association and causality between alcohol intake and BMD.

METHODS

Based on the 2005-2020 National Health and Nutrition Examination Survey including 14,113 participants, we conducted co-variate-adjusted multilinear regression analyses to explore the association between alcohol intake levels and spine or femur BMD. To evaluate the causal association between alcohol intake frequency and bone mineral density, the inverse variance weighted approach of two-sample Mendelian randomization (MR) was used with genetic data from the Medical Research Council Integrative Epidemiology Unit (462,346 cases) for alcohol intake frequency and the Genetic Factors for Osteoporosis Consortium (28,496 cases) for lumbar spine and femur neck BMD (32,735 cases).

RESULTS

Compared with non-drinkers, total femur BMDs but not total spine BMD increased with daily alcohol intake in males (β = 3.63*10-2 for mild drinkers, β = 4.21*10-2 for moderate drinkers, and β = 4.26*10-2 for heavy drinkers). By contrast, the higher total spine BMD in females was related to higher alcohol intake levels (β = 2.15*10-2 for mild drinkers, β = 2.59*10-2 for moderate drinkers, and β = 3.88*10-2 for heavy drinkers). Regarding the two-sample MR results, no causal relationship was observed between alcohol intake frequency and lumbar spine BMD (odds ratio [OR] = 1.016, P = 0.789) or femur neck BMD (OR = 1.048, P = 0.333).

CONCLUSION

This study suggests a positive association between alcohol intake frequency and BMD, although the causal relationship was not significant.

Comparison of Alveolar Bone Level around Osseointegrated Dental Implants among Premenopausal and Postmenopausal Women: A 2-Year Study

The success of dental implants is affected by bone quality and quantity at the dental implant site. The present study was done to assess the changes in alveolar bone level around osseointegrated dental implants over a period of 2 years among the premenopausal and postmenopausal women. This prospective clinical study was conducted among 50 female patients who reported between January 2020-June 2020 and had a single missing molar in maxillary or mandibular arch. Patients were categorized into 2 groups: premenopause patients (Group A; n = 25) and postmenopause patients (Group B; n = 25). Marginal bone loss (MBL) was recorded at baseline, 12 mo and 24 mo follow-up and compared between both the groups using independent t-test. ANOVA was done to compare MBL between different time periods. On intragroup comparison, a statistically significant difference was observed between different time periods in both Group A (P = 0.05) and Group B (P = 0.04). Also, on intergroup comparison, a statistically significant difference was observed in Group B from Group A at 12 mo and 24 mo (P < 0.05). Increase in marginal bone loss was observed among postmenopausal women. Therefore, clinicians should emphasize the need for oral hygiene maintenance among postmenopausal women for peri-implant health.

The Influences of Macronutrients on Bone Mineral Density, Bone Turnover Markers, and Fracture Risk in Elderly People: A Review of Human Studies

Osteoporosis is a health condition that involves weak bone mass and a deteriorated microstructure, which consequently lead to an increased risk of bone fractures with age. In elderly people, a fracture attributable to osteoporosis elevates mortality. The objective of this review was to examine the effects of macronutrients on bone mineral density (BMD), bone turnover markers (BTMs), and bone fracture in elderly people based on human studies. A systematic search was conducted in the PubMed®/MEDLINE® database. We included human studies published up to April 2023 that investigated the association between macronutrient intake and bone health outcomes. A total of 11 meta-analyses and 127 individual human studies were included after screening the records. Carbohydrate consumption seemed to have neutral effects on bone fracture in limited studies, but human studies on carbohydrates' effects on BMD or/and BTMs are needed. The human studies analyzed herein did not clearly show whether the intake of animal, vegetable, soy, or milk basic proteins has beneficial effects on bone health due to inconsistent results. Moreover, several individual human studies indicated an association between eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and osteocalcin. Further studies are required to draw a clear association between macronutrients and bone health in elderly people.

Bone Health in Adults With Prader-Willi Syndrome: Clinical Recommendations Based on a Multicenter Cohort Study

CONTEXT

Prader-Willi syndrome (PWS) is a rare complex genetic syndrome, characterized by delayed psychomotor development, hypotonia, and hyperphagia. Hormone deficiencies such as hypogonadism, hypothyroidism, and growth hormone deficiency are common. The combination of hypotonia, low physical activity, and hypogonadism might lead to a decrease in bone mass and increase in fracture risk. Moreover, one would expect an increased risk of scoliosis due to hypotonia and low physical activity.

OBJECTIVE

To study the prevalence and risk factors for skeletal problems (reduced bone mineral density, fractures, and scoliosis) in adults with PWS.

METHODS

We retrospectively collected patient characteristics, medical history, medication, biochemical measurements, dual-energy X-ray absorptiometry scans, and spinal X-rays and reviewed the current literature.

RESULTS

We included 354 adults with PWS (median age 31 years; 43% males), of whom 51 (14%) had osteoporosis (T-score below -2.5) and 143 (54%) had osteopenia (T-score -1 to -2.5). The most prevalent modifiable risk factors for osteoporosis were hypogonadism, insufficient dairy intake, sedentary lifestyle, and corticosteroid use. Male sex was associated with osteoporosis (P = .005). Growth hormone treatment was not associated with osteoporosis. A history of vertebral fractures was present in 10 (3%) and nonvertebral fractures in 59 (17%). Scoliosis was present in 263 (80%), but no modifiable risk factors were identified.

CONCLUSION

Besides scoliosis, osteoporosis is common in adults with PWS. Based on the literature and the risk factors for osteoporosis found in our cohort, we provide practical clinical recommendations to avoid skeletal complications in these vulnerable patients.

The Role of Soy Isoflavones in the Prevention of Bone Loss in Postmenopausal Women: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

The aim of the report was to determine the effects of soy isoflavones on lumbar spine, femoral neck, and total hip bone mineral density (BMD) in menopausal women. MEDLINE (PubMed), EMBASE, and Cochrane Library databases were searched for articles published in English during 1995–2019. Studies were identified and reviewed for inclusion and exclusion eligibility. Weighted mean differences (WMD) were calculated for each study and were pooled by using the random effects model. Eighteen randomized controlled trials were selected for meta-analysis. Different types of soy phytoestrogens, i.e., genistein extracts, soy isoflavones extracts, soy protein isolate, and foods containing diverse amounts of isoflavones were used in the studies. The analysis showed that daily intake of 106 (range, 40–300) mg of isoflavones for 6–24 months moderately but statistically significantly positively affects BMD, compared with controls: lumbar spine WMD = 1.63 (95% CI: 0.51 to 2.75)%, p = 0004; femoral neck WMD = 1.87 (95% CI: 0.14 to 3.60)%, p = 0.034; and total hip WMD = 0.39 (95% CI: 0.08 to 0.69)%, p = 0.013. Subgroups analyses indicated that the varying effects of isoflavones on BMD across the trials might be associated with intervention duration, racial diversity (Caucasian, Asian), time after menopause, form of supplements (especially genistein), and dose of isoflavones. Our review and meta-analysis suggest that soy isoflavones are effective in slowing down bone loss after menopause.

What is normal bone health? A bioarchaeological perspective on meaningful measures and interpretations of bone strength, loss, and aging

Bioarchaeological (the study of archeological human remains together with contextual and documentary evidence) offers a unique vantage point to examine variation in skeletal morphology related to influences such as activity, disease, and nutrition. The human skeleton is composed of a dynamic tissue that is forged by biocultural factors over the entire life course, providing a record of individual, and community history. Various aspects of adult bone health, particularly bone maintenance and loss and the associated skeletal disease osteoporosis, have been examined in numerous past populations. The anthropological study of bone loss has traditionally focused on the signature of postmenopausal aging, costs of reproduction, and fragility in females. The a priori expectation of normative sex-related bone loss/fragility in bioanthropological studies illustrates the wider gender-ideological bias that continues in research design and data analysis in the field. Contextualized data on bone maintenance and aging in the archeological record show that patterns of bone loss do not constitute predictable consequences of aging or biological sex. Instead, the critical examination of bioarchaeological data highlights the complex and changing processes that craft the human body over the life course, and calls for us to question the ideal or "normal" range of bone quantity and quality in the human skeleton, and to critically reflect on what measures are actually biologically and/or socially meaningful.

Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005-2014

Osteoporosis is a major public health problem worldwide. Lower peak bone mineral density (BMD) in youth may be the single most important factor leading to the development of osteoporosis in the elderly. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2005-2014, we included 18,713 individuals with complete and valid data on femoral neck, total hip and lumbar spine BMD. Generalized additive models were used to estimate the age at attainment of peak BMD and 95% confidence intervals (95%Cls); model covariates were sex, race, body mass index (BMI) and we also examine factors potentially affecting age at attainment of peak BMD. This study clearly stated that age at attainment of peak femoral neck, total hip and lumbar spine BMD were 20.5 years, 21.2 years and 23.6 years in males, and 18.7 years, 19.0 years and 20.1 years in females, respectively and age at attainment of peak BMD varied by skeletal sites and sex. The study also found that females achieved peak femoral neck, total hip and lumbar spine BMD earlier than males (all P < 0.001); race and BMI were not associated with the age at attainment of peak BMD (all P > 0.05). These results suggested that improving bone health among individuals before 20 years old may be useful for reducing future risk of osteoporosis and osteoporotic fractures.

Image-based analysis of trabecular bone in osteoporotic rabbits: correlation of morphological features and bone mineral density profile

OBJECTIVE

To analyse a set of morphological features from digital radiographs (RX) and bone mineral density (BMD) values estimated from quantitative computerized tomography scans (QCT scans) of the knee joint of an osteoporotic rabbits, and to determine the relationship and correlation of these variables to be considered as an alternative diagnosis method.

METHODS

The knee joint of rabbits (N = 9 ovariectomized and injected with of methylprednisolone sodium succinate (OVX + MPSS) and 3 sham operated healthy controls) were subjected to radiographic examination before the beginning of the study and after 6 weeks; after sacrifice, they were immediately scanned with a 64-channel CT. A set of morphological features was extracted from RX images and then subjected to Principal Component Analysis (PCA); BMD-values were calculated at different depths from the articular surface of the femur and the tibia. The selected morphological variables and the BMD values were correlated in order to determine useful information in medical diagnostics.

RESULTS

Ten morphological variables explained 80.39% of the total variability, but only some of them demonstrated significant differences between baseline and OVX + SSMP states and between OVX + SSMP and control. Spearman analysis showed higher positive and negative correlation of these parameters among them (r = 0.67, 0.81, 0.83 and 1); and a moderate correlation with the BMD values (r = 0.50, 0.52, 0.52 and 0.55) during the progression of osteoporosis (OP).

CONCLUSION

The Spearman's rank test supported the overall significant correlation between both, the morphological features and BMD values, making them as a reliable alternative option to the diagnosis of osteoporosis.

Bone turnover markers in women participating in a dose-finding trial of a contraceptive vaginal ring releasing Nestorone and estradiol

OBJECTIVE

To evaluate changes in the bone turnover markers CTx and P1NP during 6 months' use of novel continuous contraceptive vaginal rings delivering Nestorone (NES) 200 mcg/day and three doses of estradiol (E2) (10, 20, and 40 mcg/day).

STUDY DESIGN

This randomized trial enrolled 189 women who used two consecutive vaginal rings over 180 days. Frequent blood sampling permitted analysis of NES, E2, CTx and P1NP concentrations. The bone-turnover marker analyses included only women with complete sampling and excluded women with characteristics that might interfere with accurate measurement of bone markers such as afternoon sampling, poor ring compliance or recent pregnancy. We evaluated the change from baseline to 6 months in CTx and P1NP, stratified by ring dose and by average circulating E2 concentrations.

RESULTS

One hundred fifty-one women completed the study, and 82 women had complete data available for the bone marker analyses; the three dosage groups were balanced with regard to baseline characteristics. E2 concentrations remained low throughout treatment, regardless of which dose ring the participant used. Individual CTx changes from baseline averaged 27±56% (p<.01). Similarly, individual P1NP changes averaged 11±33% (p=.04). These increases were within the premenopausal reference ranges, and unrelated to treatment dose or to circulating E2 concentrations.

CONCLUSIONS

The low E2 dose of these rings was associated with low E2 concentrations and modest increases in serum bone turnover makers. Because we have only 6-month bone turnover markers and no direct evidence of bone loss or bone density change, these results must be interpreted with caution.

IMPLICATIONS

Nestorone, a 19-norprogesterone derivative, leads to complete ovarian suppression, which should yield excellent contraceptive effectiveness. To prevent potential adverse effects on bone, the NES contraceptive ring should be combined with higher doses of E2 than were assessed in this study.

Is There Causal Relationship of Smoking and Alcohol Consumption with Bone Mineral Density? A Mendelian Randomization Study

Observational studies examining associations of smoking and alcohol consumption with bone mineral density (BMD) have generated inconsistent results and suffer from several methodological limitations. We aim to evaluate whether there are causal associations between smoking, alcohol consumption, and BMD using a Mendelian randomization (MR) design. Genetic variants associated with smoking status (n = 142), no. of cigarettes smoked per day (CPD) (n = 3), smoking initiation (n = 1), and alcohol consumption (n = 6) identified in published genome-wide association studies (GWAS) were used as instruments. Summary statistics data of 32735, 28498, 8143, and 445921 European subjects included in The GEnetic Factors for Osteoporosis Consortium or UK Biobank were used to generate associations of genetically predicted smoking or alcohol consumption with femoral neck (FN-BMD), lumbar spine (LS-BMD), forearm (FA-BMD), and heel BMD, respectively, by using the inverse-variance weighted method. The BMD was measured using either ultrasound (for heel) or Dual-energy X-ray Absorptiometry (for others). In our analyses, smoking status tended to be negatively associated with several types of BMD (heel BMD: β = - 0.053, p = 0.003; FN-BMD: β = - 0.139, p = 0.053; FA-BMD: β = - 0.264, p = 0.077), although the association with LS-BMD was null. Smoking initiation was significantly inversely associated with heel BMD (β = - 0.201, p = 3.60 × 10^-8). CPD was associated with a lower FN-BMD (β = - 0.014, p = 0.047) only. There was no clear association of genetically predicted alcohol consumption with BMD. Our study provided some evidence of a potential association between genetically predicted smoking and lower BMD, especially for heel BMD, but not for alcohol consumption. Considering the inconsistent findings with the different types of BMD and limitations of the current work, further studies are needed to better characterize the exact relationship between smoking, alcohol consumption, and BMD.

Association between Lumbar Bone Mineral Density and Carotid Intima-Media Thickness in Korean Adults: a Cross-sectional Study of Healthy Twin Study

Bone mineral density (BMD) has been suggested to be associated with atherosclerosis. In the present study, we evaluated the association between lumbar BMD and the segments of carotid intima-media thickness (CIMT), a surrogate marker of subclinical atherosclerosis, in Korean adults, with consideration of sex and menopause status. Among 1,679 Korean adults who enrolled in a Healthy Twin Study, 723 men, 690 premenopausal women, and 266 postmenopausal women measured the CIMT at the common carotid artery intima-media thickness (CCA-IMT), carotid bifurcation intima-media thickness (BIF-IMT), internal carotid artery intima-media thickness (ICA-IMT) using B-mode ultrasound and lumbar BMD using dual-energy X-ray absorptiometry. The composite CIMT was calculated as the mean value of three CIMTs. The association was evaluated using linear mixed models. In premenopausal women, lumbar BMD was positively associated with composite CIMT and with CCA-IMT (P = 0.008 and 0.002, respectively). However, no association was observed between BMD and CIMT in men or in postmenopausal women. Stratified analysis revealed the effect of body mass index (BMI) on the association between BMD and CIME. The positive association in premenopausal women persisted only in low BMI (< 25 kg/m²) group, whereas a positive association appeared at high BMI (≥ 25 kg/m²) group in men. A high lumbar BMD may indicate an elevated risk of subclinical atherosclerosis in premenopausal women and men with high BMI.

Predictors of bone mineral density testing among older women on Medicare

Although dual-energy X-ray absorptiometry (DXA) is recommended for all women ≥65 and is covered by Medicare, 40 % of women on Medicare report never having had a DXA. In a longitudinal cohort of 3492 women followed for two decades, we identified several risk factors that should be targeted to improve DXA testing rates.

INTRODUCTION

DXA is used to measure bone mineral density, screen for osteoporosis, and assess fracture risk. DXA is recommended for all women ≥65 years old. Although Medicare covers DXA every 24 months for women, about 40 % report never having had a DXA test, and little is known from prospective cohort studies about which subgroups of women have low use rates and should be targeted for interventions. Our objective was to identify predictors of DXA use in a nationally representative cohort of women on Medicare.

METHODS

We used baseline and biennial follow-up survey data (1993-2012) for 3492 women ≥70 years old from the nationally representative closed cohort known as the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The survey data for these women were then linked to their Medicare claims (1991-2012), yielding 17,345 person years of observation. DXA tests were identified from the Medicare claims, and Cox proportional hazard regression models were used with both fixed and time-dependent predictors from the survey interviews including demographic characteristics, socioeconomic factors, health status, health habits, and the living environment.

RESULTS

DXA use was positively associated with being Hispanic American, better cognition, higher income, having arthritis, using other preventative services, and living in Florida or other southern states. DXA use was negatively associated with age, being African-American, being overweight or obese, having mobility limitations, and smoking.

CONCLUSIONS

Interventions to increase DXA use should target the characteristics that were observed here to be negatively associated with such screening.

Does Tobacco Use Attenuate Benefits of Early Decompression in Patients With Cervical Myelopathy?

STUDY DESIGN

A retrospective cohort.

OBJECTIVE

This study investigates the interplay between duration of preoperative symptoms and smoking status with respect to postoperative outcomes in patients with cervical spondylotic myelopathy (CSM).

SUMMARY OF BACKGROUND DATA

Many studies have established the harms of smoking and several have identified the benefits of early decompression in patients with cervical myelopathy, but to our knowledge, none have assessed the relationship between these two variables.

METHODS

The medical records of all 212 patients operated on by the senior author between March 2005 and July 2012 were reviewed. Inclusion criteria were the diagnosis of CSM with a Nurick score, surgical intervention, and at least 2 years of follow-up. Patients were categorized according to smoking status and quantification of tobacco use by packs per day and pack-years, and duration of symptoms according to thresholds of 6, 12, or 24 months. Age, sex, preoperative Nurick score, duration of preoperative symptoms, duration of follow-up, procedure performed, prior surgery, number of levels operated on, diabetes status, ethanol use, and signal change on preoperative magnetic resonance imaging were also recorded for ordered logistical regression analysis.

RESULTS

One hundred twenty-five patients met all criteria. Eighty patients were smokers and 45 were nonsmokers. The median change in Nurick score for nonsmokers was 2 compared with 1 in smokers. Nonsmokers had a statistically significant likelihood of decreased change in Nurick score for symptom duration of greater than 24 months (odds ratio = 0.06, P = 0.0025). Smokers did not show a significant difference in the change in Nurick score for any threshold of symptom duration.

CONCLUSION

Increased duration of symptoms significantly affects outcomes in surgical decompression of CSM. A history of cigarette use may attenuate the benefit of early decompression and results in lower improvement in Nurick score regardless of symptom duration.

LEVEL OF EVIDENCE

3.

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

Comparison of vertebral and femoral bone mineral density in adult females

[Purpose] This study assessed vertebral and femoral bone mineral density in adult females. [Subjects and Methods] A total of 314 females in their 40s to 70s were divided into normal, osteopenia, and osteoporosis groups and their vertebral and femoral bone mineral densities were compared. [Results] Comparisons of T scores revealed significant differences among measurements of the third lumbar vertebra, femoral neck, Ward's triangle, and femoral trochanter. Pearson correlation coefficients were used to assess differences between the vertebral and femoral measurements, and significant differences and positive correlations were observed among third lumbar vertebra, femoral neck, Ward's triangle, and femur trochanter in the normal group. [Conclusion] Females in the normal, osteopenia, and osteoporosis groups showed significant differences in their third lumbar vertebrae. The lack of significant differences among measurements in the osteoporosis group in this study suggests that patients with osteoporosis require careful and accurate diagnosis.

Osteopenia and osteoporosis among 16-65 year old women attending outpatient clinics

Women living in developing countries are more prone to osteoporotic fractures than women in developed countries. The objectives of this study were to estimate the burden of osteopenia and osteoporosis and examine their correlates among Bangladeshi women. This cross-sectional study consisted of 500 women aged 16-65 years attending gynecology and family planning clinics of a tertiary hospital which cares urban/suburban low income population in Dhaka, Bangladesh. Bone mineral density (BMD) was measured at the lumbar spine and femoral neck using dual X-ray absorptiometry. We calculated T scores based on sex-matched reference data from Caucasian women provided by the manufacturer. Osteoporosis was defined as a BMD at either site more than 2.5 standard deviations (SD) below the young healthy adult woman mean while the osteopenia was defined as a BMD between 1 and 2.5 SD below the mean as suggested by the World Health Organization. Separate multivariable logistic regression analysis was used to examine the correlates of osteopenia/osteoporosis among 16-45 and 46-65 year old women. Overall, 43.6 and 5.5 % of 16-45 year old women, and 40.7 and 41.8 % of 46-65 year old women had osteopenia and osteoporosis based on T scores either of the two sites (lumbar spine or femoral neck), respectively. Body mass index was negatively associated with osteopenia/osteoporosis at both lumbar spine and femoral neck, while age was positively associated. The burden of osteopenia/osteoporosis is very high in Bangladeshi women which warrants appropriate interventional strategies to minimize future fractures and reduce related social and economic burden of the society.

The Effect of Smoking on Spinal Cord Healing Following Surgical Treatment of Cervical Myelopathy

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

The purpose of this study was to compare outcomes of surgical treatment of cervical myelopathy between smokers and nonsmokers as assessed by the Nurick score.

SUMMARY OF BACKGROUND DATA

The harmful effects of smoking on healing have been well established. However, the effect of smoking on postoperative outcomes for cervical myelopathy has not been specifically evaluated.

METHODS

The medical records of 212 patients who underwent surgery for cervical spondylotic myelopathy were reviewed. Inclusion criteria were the diagnosis of cervical spondylotic myelopathy with a Nurick score, surgical intervention, and at least 2 years of follow-up. The patients were categorized into 2 groups according to smoking status and stratified according to pack years and packs per day. Age at presentation, sex, preoperative and postoperative Nurick score, duration of symptoms preoperatively, duration of follow-up, procedure performed, surgical approach, number of levels fused, diabetes status, cocaine use, ethanol use, preoperative magnetic resonance imaging signal change, and whether the patient belonged to the Veterans Administration (VA) were recorded. Analysis was done using simple linear regression and multiple regression.

RESULTS

Univariate analysis demonstrated a postoperative improvement in nonsmokers of 1.53 points on the Nurick scale compared with 0.6 points in smokers (P < 0.001). There is a progressive decrease in improvement as the number of pack years and packs per day increase (P < 0.001). There is a greater improvement in Nurick score with greater (worse) preoperative score but only in patients with fewer than 25 pack years. Smoking status is not associated with preoperative Nurick score.

CONCLUSION

Smoking status is associated with poor improvement in Nurick score after surgical treatment of cervical myelopathy. Smoking may have a directly toxic effect on the intrinsic healing capability of the spinal cord, particularly beyond 25 pack years.

LEVEL OF EVIDENCE

3.

O efeito da amamentação na massa óssea de mulheres na pós-menopausa: revisão sistemática de estudos observacionais

Objetivos:avaliar o efeito da amamentação na massa óssea de mulheres na pós-menopausa.Métodos:trata-se de revisão sistemática de estudos observacionais. A pesquisa da literatura foi realizada nas bases de dados bibliográficos Lilacs, Medline e Scopus, em junho de 2015, sem restrição quanto ao ano de publicação. Para ser incluído nesta revisão, o artigo deveria avaliar o histórico de amamentação e a massa óssea na pós-menopausa, sendo suas referências checadas para busca de novos estudos. Dois revisores, de forma independente, realizaram a extração de dados e a avaliação da suscetibilidade a vieses dos estudos.Resultados:foram selecionados 34 estudos, dos quais seis (26,5%) mostraram que a prática de amamentação aumentou significativamente a massa óssea e 15 (44%) encontraram o inverso. Constatou-se grande diversidade entre os estudos quanto à população de estudo, mensuração da exposição e sítios de avaliação da massa óssea, dificultando a comparabilidade entre os resultados.Conclusões:a marcante heterogeneidade dos estudos torna inconclusiva a direção da associação entre a amamentação e a massa óssea em mulheres na pós-menopausa, sendo necessários estudos com maior rigor metodológico para avaliar esse problema de grande relevância para as áreas clínica e de saúde pública.

The effect of oral contraceptive different patterns of use on circulating IGF-1 and bone mineral density in healthy premenopausal women

Both insulin-like growth factor-1(IGF-1) and oral contraceptive (OC) use have been linked to premenopausal breast and colorectal cancers, osteoporosis and cardiovascular disease. Understanding the effects of different patterns of use of OC on IGF-1 levels and bone mineral density (BMD) may offer insight into its influence on osteoporosis. We conducted a cross-sectional study, which included 135 women, who were then divided into three groups: Group A who were OC current users, 41 women; Group B who never use OC, 51 women; and Group C who were past users of OC, 41 women. Each patient completed a questionnaire on demographic parameters, marital state history and contraception history including duration of use and type of contraceptive pills or used method. Lower-end radius, proximal femur and lumbar spine BMD were measured by dual-energy X-ray absorptiometry. IGF-1 was assessed with chemiluminescent immunometric assay. The three groups were similar in total body T value of BMD (with slight better results in past users than the other two groups but it was statistically insignificant difference), and past users showed significantly higher BMD values compared to current users at spine, femur and forearm. Nonusers also had better BMD values compared to current users (spine and forearm BMD). Among past users, the mean level of circulating IGF-1 was higher than the other two groups and that difference was statistically significant. Past OC use and/or nonuse has a more favorable impact on BMD compared to current use and that this relationship is in part mediated by IGF-1. Hence, it appears that OC use is beneficial to BMD if used in the past and then discontinued or if never used at all compared to current use.

An in-school exercise intervention to enhance bone and reduce fat in girls: the CAPO Kids trial

The CAPO Kids trial was a 9-mo, controlled, school-based intervention to examine the effects of a novel, brief, high intensity exercise regime on indices of musculoskeletal and metabolic health in pre- and early-pubertal girls.

METHODS

A total of 151 pre- and early-pubertal girls (10.6±0.6years), recruited from two different schools consented to participate; 76 in the exercise group (EX) and 75 in the control group (CON). EX performed 10min bouts of thrice-weekly jumping plus capoeira (a Brazilian sport that combines martial art with dance), along with usual physical education (PE) activities. CON continued usual PE alone. Maturity, weight, height, waist circumference, resting heart rate and blood pressure, maximal vertical jump, and aerobic capacity were determined using standard clinical and field measures. Calcaneal broadband ultrasound attenuation (BUA) and stiffness index (SI) were determined from quantitative ultrasonometry. A subsample of children also underwent DXA and pQCT measures. Prior physical activity participation and daily calcium consumption were determined from validated instruments.

RESULTS

EX girls improved BUA more than CON (+4.5% vs. +1.4%, p=0.019). Resting heart rate (-7.2% vs. -1.8%, p<0.01), maximal vertical jump (+13.4% vs. -1.2%, p<0.001), estimated maximal oxygen consumption (+10.6% vs. +1.0%, p<0.001), and waist circumference (+2.7% vs. +5.6%, p<0.001) also improved more for EX than CON.

CONCLUSION

Ten minutes of high intensity exercise (capoeira and jumping) three times a week in the primary school setting enhances musculoskeletal and metabolic outcomes in pre- and early-pubertal girls without disrupting the academic schedule. The programme, amenable to broad-scale school implementation, would confer meaningful public health benefits.

The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

From 50 years of age, postmenopausal women are at an increased risk of developing sarcopenia and osteoporosis as a result of deterioration of musculoskeletal health. Both disorders increase the risk of falls and fractures. The risk of developing sarcopenia and osteoporosis may be attenuated through healthy lifestyle changes, which include adequate dietary protein, calcium and vitamin D intakes, and regular physical activity/exercise, besides hormone replacement therapy when appropriate. Protein intake and physical activity are the main anabolic stimuli for muscle protein synthesis. Exercise training leads to increased muscle mass and strength, and the combination of optimal protein intake and exercise produces a greater degree of muscle protein accretion than either intervention alone. Similarly, adequate dietary protein intake and resistance exercise are important contributors to the maintenance of bone strength. Vitamin D helps to maintain muscle mass and strength as well as bone health. These findings suggest that healthy lifestyle measures in women aged >50 years are essential to allow healthy ageing. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommends optimal dietary protein intake of 1.0-1.2g/kgbodyweight/d with at least 20-25g of high-quality protein at each main meal, with adequate vitamin D intake at 800IU/d to maintain serum 25-hydroxyvitamin D levels >50nmol/L as well as calcium intake of 1000mg/d, alongside regular physical activity/exercise 3-5 times/week combined with protein intake in close proximity to exercise, in postmenopausal women for prevention of age-related deterioration of musculoskeletal health.

Bone mineral density among elderly patients with chronic obstructive pulmonary disease patients in India

BACKGROUND

Osteoporosis is one of the major extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), which limits the physical activity. The present study was undertaken to study the bone mineral density (BMD) and osteoporosis in the elderly COPD patients.

MATERIALS AND METHODS

This was a cross-sectional study carried out among elderly COPD patients. After a detailed clinical history spirometry was done to stage the severity of COPD. DEXA scan of the lumbar spine was performed using bone densitometer to determine osteoporosis. Statistical analysis was based on Chi-square test. Risk factors were identified by univariate and multivariate logistic regression analysis.

RESULTS

A total of 70 elderly COPD patients were included. Fourty-six patients (65.7%) had osteoporosis and 13 (18.6%) had osteopenia. Majority of the osteoporosis patients had stage III or stage IV COPD disease (77.2%). As the severity grade of COPD increased, the risk of osteoporosis also increased. Also, with the increasing severity of COPD, BMD decreased. Patients with lower body mass index (BMI) had higher prevalence of osteoporosis (45.7%). Using multivariate regression analysis, stage IV COPD, number of acute exacerbations >3 and steroid cumulative dose >1000 mg were independent risk factors for osteoporosis in elderly COPD patients.

CONCLUSIONS

The prevalence of osteoporosis was 65.7%, and 18.6% had osteopenia. Stage III and IV patients had significantly lower BMI in elderly COPD patients. High clinical suspicion and early diagnosis and treatment are required in the evaluation of osteoporosis in elderly COPD patients.

Osteoporosis and atherosclerosis: a post-mortem MDCT study of an elderly cohort

OBJECTIVES

To evaluate how far fracture status and bone mineral density (BMD) correlate with the vascular calcification score (CS).

METHODS

On 29 complete human cadavers (17 female, 12 male; mean age at death was 85.57 years), multi-detector computed tomography was performed to assess the spine fracture status (fracture vs non-fracture [FX vs non-FX]) and CS of the coronary arteries (Coro-CS), the aorta (Aorta-CS) and the pelvic vessels (Iliac-CS). Quantitative computed tomography of the lumbar spine was performed to estimate overall BMD (osteoporotic [BMD <80 mg/cm(3)] vs non-osteoporotic [BMD ≥ 80 mg/cm(3)]).

RESULTS

Gender-specific differences in statistical significance were only observed for Aorta-CS and Iliac-CS but not for Coro-CS. When comparing the osteoporotic with the non-osteoporotic group, statistically significant differences were only found for Iliac-CS (P < 0.05); however, linear regression analysis showed none of the CSs to significantly correlate with BMD.

CONCLUSIONS

In our small post-mortem elderly population, statistically significant associations of fracture status and BMD with CS were only observed between the osteoporotic and non-osteoporotic groups for the pelvic vessels but not for the coronary arteries and the aorta.

KEY POINTS

• Gender-specific differences were observed for aortic and iliac calcification score (CS). • There was no difference in coronary CS between females and males. • Only iliac CS was different in osteoporotic and non-osteoporotic subjects. • In linear regression analysis, CS showed no correlation with BMD. • In univariate analysis, gender was a BMD and iliac CS confounder.

The musculoskeletal effects of cigarette smoking

➤ Cigarette smoking decreases bone mineral density and increases the risk of sustaining a fracture or tendon injury, with partial reversibility of these risks with long-term cessation of smoking. ➤ Cigarette smoking increases the risk for perioperative complications, nonunion and delayed union of fractures, infection, and soft-tissue and wound-healing complications. ➤ Brief preoperative cessation of smoking may mitigate these perioperative risks. ➤ Informed-consent discussions should include notification of the higher risk of perioperative complications with cigarette smoking and the benefits of temporary cessation of smoking.

Inflammatory bowel disease has a small effect on bone mineral density and risk for osteoporosis

BACKGROUND & AIMS

A high prevalence of osteoporosis has been reported among individuals with inflammatory bowel disease (IBD). We performed a population-based analysis to determine whether IBD is itself a risk factor for low bone mineral density (BMD) or whether low BMD results from other factors associated with IBD.

METHODS

We identified 1230 subjects with IBD in the Manitoba BMD Database, which contains results of BMD tests performed on all Manitobans since 1997 (n = 45,714). BMD was assessed at the lumbar spine (mean value, L1-L4), hip (total), femoral neck, and trochanter. Multivariate linear and logistic regression analyses were performed to determine the independent effects of IBD, Crohn's disease (CD), or ulcerative colitis (UC) on T score and the presence of osteoporosis (a low T score was equal to or less than -2.5) at any site; we controlled for age, sex, body mass index, hormone replacement therapy, osteoprotective medications, and corticosteroid use. We also performed regression analysis within the IBD population to determine the effect of IBD-specific factors on T score and osteoporosis.

RESULTS

IBD was associated with a statistically significant but small effect on T score; IBD did not increase the risk for osteoporosis at any site measured. CD was associated with an increased risk of osteoporosis at the lumbar spine and trochanter, but UC was not associated with an increased risk of osteoporosis or low T score. No IBD-specific variables were associated with increased risk of osteoporosis or low T score.

CONCLUSIONS

IBD has a small effect on BMD; CD poses a greater risk than UC. The risk of osteoporosis in patients with IBD appears to be related to other known osteoporosis risk factors.

The impact of serum FSH and estradiol on postmenopausal osteoporosis related to time since menopause

AIM

To determine the impact on osteopenia/osteoporosis of serum follicle-stimulating hormone (FSH), estradiol levels and time since menopause in a group of Turkish postmenopausal women.

METHODS

Four hundred and thirty-three healthy postmenopausal women seen at the Marmara University Menopause Outpatient Clinic were enrolled for this prospective cohort study. The women were allocated to one of three groups according to the bone mineral density (BMD) of the lumbar vertebrae and total hip, as measured by dual energy X-ray absorptiometry (DEXA). Serum FSH, estradiol levels, age and time since menopause were compared between the groups.

RESULTS

The mean serum FSH, LH, estradiol and testosterone levels for women with normal, osteopenic and osteoporotic BMD at lumbar vertrebra L1-L4 and total hip were comparable. Time since menopause had a stronger predictive value for low BMD (osteopenia or osteoporosis) in the lumbar and hip areas than did serum FSH or estradiol levels.

CONCLUSIONS

Our study showed that neither FSH nor E2 has a strong impact on postmenopausal BMD. However it appears that time since menopause has a weak non-significant association with postmenopausal osteopenia and osteoporosis.

Alcohol consumption and bone mineral density in elderly women

OBJECTIVE

Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.

DESIGN

This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention - Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.

SETTING

Kuopio Province, Finland.

SUBJECTS

Three hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.

RESULTS

Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1-3 alcoholic beverages/week at the lumbar spine, compared with non-users.

CONCLUSIONS

The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

Assessment of age and sex by means of DXA bone densitometry: application in forensic anthropology

Today we are witnessing a genuine revolution in diagnostic imaging techniques. Dual X-ray absorptiometry (DEXA) quantifies bone mineral density (BMD) and bone mineral content (BMC). This technique has rarely been used in Forensic Anthropology, although its practical application has been demonstrated by various authors. In this article, we look into the conduct of bone mineral density in the femoral neck, the trochanter, the intertrochanter, the proximal femur and Ward's triangle, in relation to anthropometric age and sex parameters. The research was carried out on 70 persons - 38 men and 32 women - and the results obtained show significant correlations between bone mineral density measurements and anthropometric values. The research demonstrates bone mineral density to be a useful technique for sex and age data in forensic anthropology, particularly in the measurements observed in the Ward's triangle area.

Lumbar Spine and Total Body Bone Mass in Healthy Elderly Men and Women

La masse de la colonne vertébrale lombaire ainsi que la masse osseuse totale ont été déterminées chez 119 hommes et femmes âgés en bonne santé par la technique d'absorptiométrie bi-photonique. Le taux de perte du contenu minéral de la colonne vertébrale lombaire est le même chez l'homme âgé et chez la femme âgée, et n'est, sans doute, pas différent du taux accepté pour les jeunes adultes. Chez les femmes âgées, nous avons mesuré une perte annuelle significative de 24 g du contenu minéral osseux du squelette. Le plus important indice de prédiction de la masse osseuse est le poids de la personne. Des variables représentant la santé physique ou la force, seule la force du bras contribue à la variation de la masse osseuse, étant responsable de 4 pour cent de la variation dans la densité du minéral osseux de la colonne vertébrale lombaire de la femme.

Factores de riesgo que afectan la fusión en el tratamiento de la inestabilidad en la columna lumbar

OBJETIVO: describir cuales son los factores de riesgo que afectan la fusión vertebral en la inestabilidad de la columna lumbar, en pacientes atendidos en nuestro hospital relacionados con los aspectos nutricionales. MÉTODOS: se revisaron 59 pacientes de los cuales 15 (25,4%) fueron casos (pseudoartrosis) y 44 (74,6%) fueron controles (fusión). La distribución demográfica presentó pacientes, de los cuales 27 (45,8%) correspondieron al sexo femenino y 32 (54,2%) al sexo masculino. El promedio de edad fue de de 51 con una desviacion standard de 12, una mínima de 20 y una máxima de 85 años. Su distribución por diagnostico fue 29 (49,1%) espondilolistesis; 21 (35,6%) fracturas; 5 (8,5%) hernias discales; 3 (5,1%) infecciones y 1 (1,7%) tumoración. El peso promedio fue de 75,9 kg, con una talla de 1,60 cm, el IMC de 24,5, una Hb de 15,2, Hto de 35,9, y albúmina de 3,5. RESULTADOS: se analizaron diversos factores de riesgo, entre la edad de mayores de 60 años, se mostró un 49% más probabilidad de una pseudoartrosis en comparación con el Grupo Control con un IC 95%=0,12-2,27. El peso mayor de 90 kg mostró un 82% más probabilidad de una pseudoartrosis en comparación con el Grupo de Fusión con un IC 95%=0,03-0,43, el IMC muestra un 25% más probabilidad de una pseudoartrosis con un IC 95%=0,18-3,18, la hipoalbuminemia menor de 3,4 mg/100 mL mostró un 78% más probabilidad de la pseudoartrosis, con IC 95%=0,06-0,75. CONCLUSIONES: se encontró que la pseudoartrosis es provocada por factores de riesgo asociados al perfil nutricional como lo es la propia obesidad, la hipoalbuminemia y existe una probabilidad de presentarla de 1,5 veces más, que en las personas con valores normales. Por tal motivo, es importante que dichos valores sean evaluados y corregidos de manera prematura en el momento prequirúrgico, con medidas de soporte que permitan un adecuado control metabólico y, por consecuencia, un resultado óptimo que es la fusión. NIVEL DE EVIDENCIA: estudio de casos y controles con un nivel de evidencia III.

Bone mineral density in the femoral neck increases after hip resurfacing: a cohort with five-year follow-up

Hip resurfacing is an effective treatment modality for arthritis of the hip in carefully selected patients; however, its use remains controversial due to its higher revision rates compared with conventional total hip replacement surgery. The most frequent reason for revision is femoral neck fracture, and preoperative bone mineral density is an important factor when considering the option of hip resurfacing. Whilst reduction in bone mineral density following total hip replacement is well documented, little is known about the long-term changes in femoral neck bone mineral density after hip resurfacing. We followed 15 patients (ten male and five female) who underwent unilateral hip resurfacing for osteoarthritis with standardised dual energy X-ray absorbiometry scans at two weeks, three months, one year, two years and five years postoperatively to determine changes in the femoral neck bone mineral density. Both males and females initially had decreases in bone mineral density at three months postoperatively, but had gradual mean increases to 119% of their initial measurements by five years. This study demonstrates that femoral neck bone mineral density increases after hip resurfacing and that this increase continues for at least five years.

Influence of arthritis and non-arthritis related factors on areal bone mineral density (BMDa) in women with longstanding inflammatory polyarthritis: a primary care based inception cohort

Background

The aim of this analysis was to determine the relative influence of disease and non-disease factors on areal bone mineral density (BMD_a) in a primary care based cohort of women with inflammatory polyarthritis.

Methods

Women aged 16 years and over with recent onset inflammatory polyarthritis were recruited to the Norfolk Arthritis Register (NOAR) between 1990 and 1993. Subjects were examined at both baseline and follow up for the presence of tender, swollen and deformed joints. At the 10^th anniversary visit, a sub-sample of women were invited to complete a bone health questionnaire and attend for BMD_a (Hologic, QDR 4000). Linear regression was used to examine the association between BMD_a with both (i) arthritis-related factors assessed at baseline and the 10^th anniversary visit and (ii) standard risk factors for osteoporosis. Adjustments were made for age.

Results

108 women, mean age 58.0 years were studied. Older age, decreasing weight and BMI at follow up were all associated with lower BMD_a at both the spine and femoral neck. None of the lifestyle factors were linked. Indices of joint damage including 10^th anniversary deformed joint count and erosive joint count were the arthritis-related variables linked with a reduction in BMD_a at the femoral neck. By contrast, disease activity as determined by the number of tender and or swollen joints assessed both at baseline and follow up was not linked with BMD_a at either site.

Conclusion

Cumulative disease damage was the strongest predictor of reduced femoral bone density. Other disease and lifestyle factors have only a modest influence.

Impact of passive smoking on the bones of rats

Many epidemiological surveys have identified smoking as a risk factor for osteoporosis, but it is unclear whether smoking has a direct effect on bone metabolism and if such an effect could cause osteoporosis. Therefore, we examined whether smoking causes osteoporosis based on the impact of smoke exposure on the bones of rats. A rat model of passive cigarette smoking was prepared by breeding rats in a cigarette-smoking box for 4 or 8 weeks. Histological changes, micro-computed tomographic (CT) analysis, mechanical bone strength, and bone mineral density of the femur and lumbar vertebrae were examined in these rats and in control rats that were not exposed to smoke. Lower mechanical bone strength was observed in smoke-exposed rats, but these differences were not significant. Significantly lower bone mineral density was found in the femur (P<.01) and lumbar bones (P<.001) of 8-week smoke-exposed rats compared to controls. In a micro-CT scan of lumbar vertebrae, the bone volume, trabecular thickness, trabecular number, and trabecular separation differed significantly between smoke-exposed rats and controls. Histologically, the osteocytes in the smoke-exposed rats were small (approximately 25% of the size in controls), and decreased numbers of marrow cells and osteoblasts (P<.01), as well as a black carbon dust-like substance, were found in the bone of smoke-exposed rats. These results indicate that smoking significantly decreases bone mineral density, which causes osteoporosis, and the organizational changes in the bone suggest a direct effect of smoking on bone structure. Fewer marrow cells were present in the smoke-exposed rats, and a black carbon dust-like substance was observed.

Health effects of breast feeding for mothers: a critical review

Lactation results in a number of physiological adaptations which exert direct effects on maternal health, some of which may confer both short and long term advantages for breast feeding mothers. Breast feeding in the early postpartum period promotes a more rapid return of the uterus to its prepregnant state through the actions of oxytocin. Breast feeding may also lead to a more rapid return to prepregnancy weight. Among studies that had good data on duration and intensity of lactation, the majority show a significant association between lactation and weight loss. However, there is no evidence that lactation prevents obesity. Lactation also affects glucose and lipid metabolism. The long term effects of these adaptations are unknown but may have implications for preventing subsequent development of diabetes and heart disease. Lactation delays the return of ovulation and significantly reduces fertility during the period of lactational amenorrhoea. This process is linked with feeding patterns and may therefore be affected by practices such as scheduled feedings and the timing of introduction of complementary foods. While the evidence from epidemiologic studies is mixed, several large studies have shown that extended lactation is associated with reduced risk of premenopausal breast, ovarian and endometrial cancers. Although bone mineralization declines during lactation, repletion takes place after weaning. As a result, breast feeding does not appear to cause long term depletion of bone nor does it increase risk of osteoporosis. Many of the physiological effects of lactation are dependent on the stimulation of the hypothalamic-pituitary axis and milk removal and thus may vary with infant feeding practices. Well controlled studies are needed that include detailed information regarding infant feeding practices in addition to the total duration of any breast feeding. Future feeding recommendations should reflect careful consideration of how such practices affect both infant and maternal health.

Racial difference in the correlates of bone mineral content/density and age at peak among reproductive-aged women

SUMMARY

Racial/ethnic differences were observed in age at peak bone density and their correlates, with whites peaking at least 5 years earlier at the femoral neck than black and Hispanic women. Race-specific standards generated in this study could be useful when interpreting bone densitometry data in young women.

INTRODUCTION

The influence of race/ethnicity on bone measurements has not been widely examined. This study identifies age and amount of bone accumulated at peak density and their correlates by race/ethnicity.

METHODS

Bone mineral content (BMC) and bone mineral density (BMD) of the spine and femoral neck were measured by dual X-ray absorptiometry in 708 white, black, and Hispanic reproductive-aged women. Race-specific nonlinear models were used to describe the relationship between age and bone measurements, after adjusting for body weight and height. Log-transformed bone measurements were used to determine predictors based on multiple linear regression.

RESULTS

Predictors, which were race and site specific, included age, age at menarche, body weight, height, months of depot medroxyprogesterone acetate use, weight-bearing exercise, and alcohol use. Women of all races gained BMC and BMD at the spine up to 30-33 years of age. BMC and BMD of the femoral neck peaked among white women earlier (<or=16 years) than among blacks (BMC 22 years; BMD 21 years) and Hispanics (BMC 29 years; BMD 20 years).

CONCLUSION

Age at peak bone mass and its correlates differ by race/ethnicity. Race-specific standards generated in this study could be useful when interpreting bone densitometry data in young women.

Relation between body mass index and bone mineral density among haemodialysis patients with chronic kidney disease

Renal osteodystrophy is a serious problem for patients with chronic kidney disease. Measurements of bone mineral density, T-score and Z-score were taken in the lumbar region and femur of 73 patients who were being treated on the haemodialysis programme. These measurements were compared with the anthropometric values of weight, height and body mass index (BMI) obtaining a positive correlation between them.

INTRODUCTION

Alterations in the bone mineral metabolism are an important cause of morbidity and mortality among haemodialysis patients with chronic renal failure. Bone mass diminution, together with fracture risk, is a frequent finding in these patients; this fact is explained by different factors, amongst which are those related to their anthropometric values.

MATERIALS AND METHODS

Bone mineral density (BMD) was studied, T-score and Z-score measurements were taken in the neck of the femur, trochanter, intertrochanter, 1/3 of proximal femur, Ward's triangle and L2, L3 and L4 vertebrae; body composition was also studied. With this aim, DXA densitometry was used on 73 haemodialysis patients (40 men and 33 women). The mean of the total haemodialysis time in these patients was 9.7 years. The group showed a very significant positive correlation between BMD, weight, height, BMI, fractures, dialysis time and intact PTH.

CONCLUSIONS

CKD patients undergoing the haemodialysis programme show a significant BMD reduction, which affects both lumbar spine and femur. Weight and height affect BMD and bone change, being thus important factors of prediction for fracture risk. Furthermore, BMI is the main determinant of BMD, a finding that is confirmed in the units in this study and with the evidence described by other authors (Negri et al. (2005).

Atherosclerosis and osteoporosis: age-dependent degenerative processes or related entities?

Osteoporosis and atherosclerosis, two multifactorial and degenerative entities, are major public health problems. These diseases accompany the aging process and share common risk factors. Furthermore, several common pathophysiological factors have been suggested. These include similar molecular pathways involving bone and vascular mineralization, estrogen deficiency, parathyroid hormone, homocysteine, lipid oxidation products, inflammatory process, as well as vitamin D and K. Moreover, the use of statins, biphosphonates, beta-blockers and experimental dual-purpose therapies based on the biological linkage of the above entities may simultaneously benefit bone loss and vascular disease. This review considers a potential link between osteoporosis and atherosclerosis beyond aging. These common factors may lead to appropriate treatment strategies.

Multigenerational exposure to ethinyl estradiol affects bone geometry, but not bone mineral density in rats

Estrogenic compounds are known to prevent bone loss in ovariectomized adult rats; however, their effects on bone in developing and reproductively-intact rats are less well-understood. In a large multigenerational experiment 0, 2, 10, or 50 ppb ethinyl estradiol (EE) in the diet was fed to intact male and female rats from conception until either weaning, postnatal day 140, or continuously for 2 years. Vertebrae (lumbar and caudal) and femurs were collected from subsets of these animals at necropsy at 48 days, 70 days, 140 days, or 2 years of age and subjected to dual-energy X-ray absorptiometry (DXA) scanning to measure bone mineral density (BMD), bone mineral content (BMC), and bone area. In addition, the length, cross-sectional area, marrow area, and cortical bone area of the femurs were measured directly in all animals at PND 140 and 2 years. Continuous dietary intake of 50 ppb EE decreased body weight by 8-27%. BMD adjusted for body weight was not affected by EE, with the exception of an increase in the caudal vertebrae in males treated with 50 ppb EE. In female rats, continuous treatment with 50 ppb EE decreased length and cross-sectional area of the femur. The length of the femur was decreased in the first two generations following institution of a phytoestrogen-free diet at the initiation of the study in all animals, including controls, but returned to the original length by the third or fourth generation. The cross-sectional area of the femur also varied by generation. In conclusion, a high dose of EE throughout the lifespan resulted in decreased bone size in females, which could reduce the force required to break the bone. Furthermore, dietary changes may have epigenetic effects which persist for multiple generations.

Estrogen-progestin contraceptive use during adolescence prevents bone mass acquisition: a 4-year follow-up study

BACKGROUND

Estrogen-progestin contraception may affect estrogen production and alter the development of peak bone mass.

STUDY DESIGN

A 4-year follow-up with 122 adolescent women aged 12-19 years. The data were divided into three groups based on estrogen-progestin contraceptive (EPC) use: (i) nonusers (n=52), (ii) 1-2 years of use (n=24) and (iii) use for more than 2 years (n=46). The estrogen dose of the preparations was < or =35 mcg. Height, weight, and the amount of exercise (ratio of work metabolic rate, h/week) as well as bone mineral content (BMC) of lumbar spine and femoral neck were measured repeatedly.

RESULTS

There was a significant trend showing less of an increase in the mean adjusted BMC of lumbar spine in the group of adolescent women who had used EPC for more than 2 years compared with the two other groups. In the mean adjusted BMC of the femoral neck, there was a significant trend of a smaller increase in EPC users for more than 2 years compared with 1-2 years of use.

CONCLUSIONS

Long-term EPC with low-dose estrogen preparations seems to suppress normal bone mineral accrual in adolescent women.

Vitamin D deficiency and low bone status in adult female garment factory workers in Bangladesh

The manufacture of garments is the main industry in Bangladesh and employs 1·6 million female workers. Due to the indoor lifestyle and low dietary intake of calcium, we hypothesised that they are at risk of low vitamin D and bone mineral status. Two hundred female garment workers (aged 18–36 years) were randomly selected. Serum 25-hydroxyvitamin D (S-25OHD), serum intact parathyroid hormone (S-iPTH), serum calcium (S-Ca), serum phosphate (S-P) concentration and serum alkaline phosphatase activity (S-ALP) were measured from fasting samples. Bone indexes of hip and spine were measured by dual-energy X-ray absorptiometry. The mean S-25OHD (36·7 nmol/l) was low compared to that recommended for vitamin D sufficiency. About 16 % of the subjects were found to be vitamin D-deficient (S-25OHD < 25 nmol/l). We observed a high prevalence (88·5 %) of vitamin D insufficiency (S-25OHD < 50 nmol/l) as well as a significant inverse relationship between S-25OHD and S-iPTH (r − 0·25, P ≤ 0·001). A decrease in S-25OHD ( < 38 nmol/l) and an increase in S-iPTH (>21 ng/l) was associated with progressive reduction in bone mineral density at the femoral neck and lumbar spine. According to the WHO criteria, the mean T-score of the femoral neck and lumbar spine of the subjects were within osteopenic range. We observed that subjects with a bone mineral density T-score < − 2·5 had a trend of lower values of BMI, waist–hip circumference, mid-upper-arm circumference, S-25OHD and higher S-iPTH and S-ALP. The high prevalence of hypovitaminosis D and low bone mineral density among these subjects are indicative of higher risk for osteomalacia or osteoporosis and fracture.

The impact of clothing style on bone mineral density among women in Turkey

To investigate the effect of veiled clothing style on bone mineral density (BMD). The BMD measurements were performed on the femoral neck and the lumbar spines of adult female population with two different types of clothing taking calcium daily in the normal range according to the proper technique utilizing dual energy X-ray absorptiometry (DEXA). In the lumbar spine measurements, the BMD was measured 1.0020 +/- 0.177 gr/cm2 in cases with veiled clothing style while it was measured 1.0793 +/- 0.169 gr/cm2 in cases with unveiled clothing style (P = 0.049, t = 1.98). In the femoral neck measurements, the BMD was measured 0.8428 +/- 0.146 gr/cm2 in cases with veiled clothing style while it was measured 0.8532 +/- 0.177 in cases with unveiled clothing style (P = 0.548, t = 0.457). Although a decrease in BMD values was observed in both regions with veiled clothing style, only the change in the lumbar spine BMD measurements was statistically significant. These findings suggest that the veiled clothing style may have an adverse effect on BMD by interfering with the sun exposure which is believed to have a key role in bone strength.

Bone density in relation to alcohol intake among men and women in the United States

Studies of postmenopausal women have shown a positive association between BMD and alcohol intake. We found that BMD was higher in men, and possibly postmenopausal women, who drank alcohol compared with those who abstained. Drinking alcohol, but not binge drinking, may benefit bone health of men and postmenopausal women.

INTRODUCTION

Osteoporotic fractures account for over 2.5 million physician visits annually for persons ages >or=45 years in the United States. Studies of postmenopausal women show a positive association between bone mineral density (BMD) and alcohol intake, but for men and premenopausal women, the bone-alcohol relationship remains unclear. We examined the association between total hip (TH) and femoral neck (FN) BMD and alcohol intake of men and pre- and postmenopausal women.

METHODS

We conducted multiple regression analyses using data from 13,512 persons ages >or=20 years from the Third National Health and Nutrition Examination Survey, 1988-1994. Alcohol intake and binge drinking were measured by questionnaire and hip BMD by dual energy X-ray absorptiometry (DXA).

RESULTS

Accounting for covariates, TH BMD was higher in men (n = 6,868) who had 5-29 (+2.1%, p < 0.01) and >29 drinking occasions/month (+1.7%, p < 0.05) than men who abstained. BMD of premenopausal women (n = 4,136) who drank alcohol did not differ from those who abstained. FN BMD was 3.8% higher in postmenopausal women (n = 2,043) who had >29 drinking occasions/month than those who abstained (p = 0.06). Binge drinking was not associated with BMD of men or women.

CONCLUSIONS

Drinking alcohol, but not binge drinking, appears to be beneficial to bone health of men and possibly postmenopausal women.